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HomeMy WebLinkAboutMINUTES - 05191992 - IO.7 I.O.-7 TO: BOARD OF SUPERVISORS ?�..SE;,L °F Contra 1 L FROM: . INTERNAL OPERATIONS COMMITTEE Costa County DATE: May 11, 1992 s q_���K SUBJECT: STATUS REPORT ON AIDS AND OTHER COMMUNICABLE DISEASES IN CONTRA COSTA COUNTY SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1 . Accept the attached report from the Health Services Director and Director of Public Health on the status of the AIDS epidemic in Contra Costa County and the corresponding increase in other communicable diseases . 2 . Request the Health Services Director to make another status report to our Committee on September 14, 1992 . BACKGROUND: On February 25, 1992, the Board of Supervisors adopted a report from our Committee on the status of the AIDS epidemic in Contra Costa County and asked that another report be made to our Committee during May, 1992 . On May 11, 1992 , our Committee met with Wendel Brunner, M.D. , Director of Public Health; Francie Wise, R.N. , Director of Communicable Diseases; and Rusty Keilch, Director of AIDS Programs for the Health Services Department. We received and reviewed in some detail with Dr. Brunner the attached report which notes the number of AIDS cases to date in the County and the distribution of those cases by various factors . The report also notes the troubling spread of other communicable diseases such as tuberculosis and sexually transmitted diseases . CONTINUED ON ATTACHMENT: _DYES SIGNATURE: RECOMMENDATION OF COUN A I RATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE T , SIGNATURE(S): I . CH ODER 11(�SUNNE WRIGHT McPEAK ACTION OF BOARD ON May 19, 1992 APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X_UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. jlw�CC: ATTESTED / County Administrator Health Services Director PHIL BATCHELOR,C(/RK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Public Health Director Francie Wise, Public Health Division, HSD BY DEPUTY M382 (10/88) I.O.-7 -2- Particularly troubling is the fact that, as it was reported to our Committee, the County is receiving some $500,000 annually in funds from the State of California for AIDS Programs. Approximately $240,000 of this money is for prevention and education program, which are generally agreed to be the only ways currently available to prevent the spread of AIDS. This prevention money is in grave danger because of the State's fiscal problems . The federal Ryan White money the County receives is entirely for treatment and support programs for persons already diagnosed with AIDS. None of this federal money goes for education or prevention. Thus, any reduction or loss of the available State education and prevention dollars substantially impairs the ability of the County to reach many of the at-risk individuals who may become tomorrow's treatment and support cases. Our Committee is also troubled with the increase in tuberculosis cases and with the runaway growth in sexually transmitted diseases such as congenital syphilis, penicillin resistant gonorrhea and chlamydia. We hope that additional resources can be directed toward these serious problems in the future, although the County' s current fiscal problems do not provide much hope that this will occur in the near future. Contra Costa Count x The Board of Supervisors OFFICE OF THE DIRECTOR HEALTH SERVICES DEPARTMENT tYTam'PowersA'Isi"District Mark Finucane, Director Nancy C. Fanden. 2nd District obert I. Schroder, 3rd District :-��-=•'' _ :•\\ 20 Allen Street urine Wright McPeak, 4th District Tom Torfakson, 5th District '' � ��r, �� Martinez, California 94553-3191 �q Vb (510) 370-5003 510 County Administrator " 370-5098 Fax .Phil Batchelor "County Administrator May 7, 1992 To: Internal Operations Committee From: Mark Finucane, Director, Health Services Department by Wendel Brunner, M. D., Assistant Health Services Director for Public Health Subject: Quarterly Report on Communicable Diseases Attached is an update of communicable disease issues in the last quarter of the year. As you will note: _"• There are now 735 Contra Costans who have been diagnosed with AIDS. The Ryan White CARE Act will bring$662,591 into Contra Costa County for - services for people with HIV Disease in 1992-93. We anticipate significant State cuts in 1992-93 for AIDS prevention, testing and �. surveillance. , °° •. In Contra Costa, as in the nation, we are continuing our efforts to stem increases in TB. We are particularly watching trends of drug resistant TB. While we saw a slight decrease m syphilis rates in 1991, cases increased in young women (aged 15 - 19) and eight cases among women who were already pregnant . la , ,• ` .. Rates of clients coming to STD clinics with disease has increased from 7% in recent " . years to a current 20%. • - The Occupational Safety and Health Administration(OSHA) has recently released new regulations requiring those at risk for all blood-borne pathogens which includes r�w .:education, immunization and post-exposure policies. We are seeking funding to allow us to assist the City of Richmond in their implementation these new regulations. • New guidelines from CDC recommend hepatitis B immunizations for infants. These r` immunizations are costly and outside funding is not yet available to maintam`the community standard of care in our Child Health Screening Clinics and Immunization �k..� Clinics. Mernihew Memonal Hosoital 6 Clinks Public Health Mental Health Substance Abuse Environmental Health Contra Costa Health Plan Emergency Medical services Home Health Agency • Geriatrics _ Contra The Board of Supervisors Costa Health Services Department Tom Powers,1st District County Nancy C.Fanden,2nd District Robert i.Schroder,3rd District s, L OFFICE OF THE DIRECTOR Sunne Wright McPeak,4th District Tom Torlakson,5th District Mark Finucane,Director Administrative Offices County Administrator s 20 Allen Street o Martinez,California 94553 Phil Batchelor �•., —_ .. "� (415)646-4416 County Administrator °SrA------ice May 6, 1992 To: Internal Operati ns Commit ee From: Mark Finucan , it ealth Services Department by Wendel Brunner, M. D., Assistant Health Services Director for Public Health Subject: Quarterly Report on Communicable Diseases AIDS AIDS Cases Reported in Contra Costa As of April 29, 1992, 735 AIDS cases had been reported to Public Health. Of those cases, six are children: three boys; three girls; five under age five years. Of the 729 adult cases, 45 are women and of those 45 women, 34 are women of color. Of the 684.cases among males, 74% (509) are gay or bisexual men; 11% (72) are injection drug users and another six percent (39) are gay or bisexual men with a history of injection drug use. Of the 735 total cases, 465 (63%) have died. Ryan White CARE Act funds in Contra Costa County As in 1991-92, $131,724 of Title II funds from the Ryan White Comprehensive AIDS Resources Emergency Act were allocated to the Contra Costa HIV/AIDS Consortium $131,724 for 1992-93. This year, those funds have been designated to three community- based organizations. Familias Unidas and Pittsburg Preschool Coordinating Council will receive funds to continue to fund .5 FTE case managers at each agency. The Contra Costa County AIDS Task Force will receive funds to continue to fund a .75 FTE resource/case management coordinator whose tasks include coordination among AIDS service providers and administration of a voucher system, also funded through Title II funds. In 1992-93, as part of the Oakland Metropolitan Statistical Area (MSA), Alameda and Contra Costa Counties received funding from Title I of the CARE Act for the first time. By agreement between the two counties, Contra Costa's share of those funds is $530,867. Of Report to the Internal Operations Committee May 11, 1992 On Communicable Disease in Contra Costa County Page 2 that total $132,500 replaces former State and Federal funding to the AIDS Program; almost $400,000 is, therefore, new funding into the county. As directed by the Board of Supervisors in April of last year, I appointed a Contra Costa County Component to the Alameda/Contra Costa HIV Planning Council required by the CARE Act, to plan HIV services and allocate resources according to that plan. The Council put in long hours and dedicated work to assure that over $500,000 was received in our first year of funding. The Planning Council has completed its funding allocations and distributed funds as follows: Agency Funding purpose Amount AIDS Community Network .5 FTE Program Coordinator $18,720 Tranquillium Center Richmond Bay Area Addiction Re- 1.0 FTE HIV/Substance Abuse $35,000 search and Treatment Counselor Richmond & Pittsburg (.5 Richmond/.5 Pittsburg) Contra Costa County Voucher program for food, $39,544 AIDS Task Force transportation, emergency Walnut Creek housing, utilities and child care (Available to all service pro- viders) Contra Costa County AIDS 1.0 FTE Companion/Buddy $44,000 Task Force Coordinator for East Co. Walnut Creek Contra Costa County 1.5 FTE medical social work- ' $74,742 Health Services Department ers Hospital and Clinics (1.0 Richmond/.5 Pittsburg) Contra Costa County 1.0 medical social worker total: $245,393 Health Services Department 1.0 health education specialist new dollars: $112,893 Public Health Division . 1.0 PH program specialist AIDS Program 1.0 clerk Attendant care Contra Costa County .75 communicable disease $25,468 Health Services Department technician Public Health Division Health Care for Homeless Diablo Valley AIDS Center Food bank support $12,000 Diablo Valley AIDS Center .5 FTE Program Coordinator $18,000 Competitive award to be .5 FTE Housing Resource $18,000 issued Developer Report to the Internal Operations Committee May 11, 1992 On Communicable Disease in Contra Costa County Page 3 AIDS Prevention Funds While new funds for care and treatment of people with HIV are the "good news" for AIDS services in our county, we anticipate, for the second year in a row, large State cuts to AIDS services including prevention education, testing, surveillance and the case management program for the people most ill with AIDS. We are meeting (along with other AIDS Directors of Bay Area Counties) with the State Office of AIDS Chief this week to let him know the impact of these cuts to these programs. TUBERCULOSIS - OLD DISEASE, NEW EPIDEMIC Since 1987 there has been a major increase in the number of tuberculosis cases throughout the nation. In Contra Costa County we saw nearly a doubling of cases from 60 in 1986 to 108 cases in 1991. Of the 108 cases reported last year, 81% were in West Contra Costa County. TB particularly affects the homeless, children, substance abusers, HIV- infected persons and the incarcerated populations. Of additional concern is the rise of cases of drug resistant tuberculosis. In 1991, the national goal was to eliminate tuberculosis by the year 2010. Since 1985 there has been a 16% increase in the number of TB cases nation- wide. In 1991 alone there was a nine percent increase. This represents 28,000 excess cases above those expected. Tuberculosis has the hardest impact in poor communities due to crowding, poor nutrition and lack of access to adequate medical care. Because tuberculosis is spread through an airborne route, crowding into homeless shelters and other housing facilities creates a high risk environment. We are seeing many children in these high risk environments. Children are at highest risk for this disease and its most serious complications. Drug Resistant Tuberculosis The rising number of persons with drug resistant tuberculosis us if grave concern. New York experienced a major outbreak of drug resistant disease in the prison system with 13 deaths. California is just beginning to collect the data on resistance and is seeing a rise in this form of the disease. Drug resistant TB has an overall fatality rate of 50% and is both difficult and expensive to treat. Attached is a New York Times article detailing the plans of CDC to fight drug resistant TB. TB and HIV Infection Persons with HIV infection are at greatest risk for developing tuberculosis, once exposed. The disease in this population is more rapid in onset and has a greater fatality rate. In San Francisco there were 12 cases of tuberculosis in one housing facility for HIV-infected persons, all infected by one source case in a very short time period. Report to the Internal Operations Committee May 11, 1992 On Communicable Disease in Contra Costa County Page 4 Directly Observed TB Therapy in Contra Costa In Contra Costa we need to address all of these problems early with increased disease surveillance, improved access to tuberculosis screening and treatment clinics, more aggres- sive follow up of noncompliant patients and education to those at highest risk. The continua- tion and expansion of our program of directly observed therapy (DOT) is key is this effort. We have been extremely successful with this program in the past 2 years, monitoring previously noncompliant patients to insure completion of medical treatment. See the attached article from the Oakland Tribune about our very successful program with directly observed therapy. Tuberculosis in Contra Costa County New cases by year of diagnosis 140 120 120..................................••--100........ ...-- .............103.................. 100.•.......................... ...... ... so ------ ... ..- .. ... ...--- ... b0.... ...... ... ..- .. ... ...... --- 401-.--- -- 40:--- ...... ... -- .. ... ...... ... 0 1987 1988 1989 1990 1991 year of diagnosis Report to the Internal Operations Committee May 11, 1992 On Communicable Disease in Contra Costa County Page S SEXUALLY TRANSMITTED DISEASE. - A CONTINUING ISSUE Syphilis Contra Costa and the rest of the nation saw a slight decrease in the number of syphilis cases in 1991. 57% were female, Asian 2%, 74% black, 16% hispanic and 10% white. This represents an overall decrease in the total number of cases. However the most significant statistic, the percentage of female cases, has risen from 51% in 1990 to 57% in 1991. This is alarming because of their young age and because.of the potential threat to the unborn child. This decrease was due in large part to shifting STD efforts, including field investi- gation, education and many clinical services to focus on syphilis. When we first recognized the rise in syphilis in 1987 the best guess as to why the rise was occurring was that for ten years all STD effort had been focused on gonorrhea and very little effort was put into syphilis work. We cannot afford to let that happen again. Yet, even with renewed effort here and nationwide, we saw only a slight decrease in cases. We must continue to have the increased level of attention on syphilis. Early Syphilis in Contra Costa County by year of diagnosis 400 $37 350=---------------•----._.--..-.....-------------...301-------------320........ ......... • .................... 300. •........................................ .. .........230---- 250. .............................220------ 290, ----- 100. .................... 150 7 ---------•----•--•-- ..... 100 . 93 50. 0 1986 1987 1988 1909 1990 1991 cm reported through 3130192 Report to the Internal Operations Committee May 11, 1992 On Communicable Disease in Contra Costa County Page 6 Congenital Syphilis Congenital syphilis became the highest priority of the Communicable Disease program in 1989 and 1990 and the numbers of congenital syphilis cases dropped significantly in 1991. Nonetheless, congenital syphilis remains a large concern. Of the 1991 syphilis cases, ten percent were in young women 15-19 years of age; eight of the 24 were already pregnant. In years previous to 1987, one case of congenital syphilis per year was the average. It is hoped that with continued effort we will return to this rate. As with most diseases, syphilis and its long term sequelae hit infants the hardest. Congenital Syphilis in Contra Costa Co. by year of diagnosis/birth 16 14 14. ............................................................................... -- B ......................... 1Z . ... ......................................................... ......................... 10 ..................:............................................................ ... ......................... 9 ...-------------- . ......... .. ... -• --•---..................- 6 ........................................5........... ... ... ... ........------........... 4 4:,---..........3.. ...-•-- ...... -- ... 0 12 1987 1999 1989 1990 1991 year of diagnosis/birth Report to the Internal Operations Committee May 11, 1992 On Communicable Disease in Contra Costa County Page 7 Other Sexually Transmitted Diseases There are three clinics a week in Central, East and West County devoted solely to STD diagnosis and treatment, for a total of ten hours countywide. These clinics are diagnos- ing growing numbers of persons with STDs. In past years approximately 7% of the persons coming to clinic actually had disease, this percent is now over 20% and we are seeing more people in clinics each month. In 1991 in addition to a growing number of patients seen for syphilis, there has also been a significant rise in penicillin resistant gonorrhea (319 cases in 1991) and in chlamydia, (1,915 cases in 1991). Resistant Gonorrhea in Contra Costa Co. (PPNG by year of diagnosis 400 330. •--•--------------------------------------------------------------------•-----------•---------------••--------3IA--- 300. -- 230. -- .........._..-..--•----------------•---•--............................... 20017 .........................................................................................467-...... ISO. ................................•-----------------•---............................ 100,........................................................................21....... 30 ............. 29 0 1986 1987 1988 1989 1990 1991 Reported through 3/31/92 1 Report to the Internal Operations Committee May 11, 1992 On Communicable Disease in Contra Costa County Page 8 EMERGING COMMUNICABLE DISEASE ISSUES In January 1992, the Occupational Safety and Health Administration (OSHA) passed new regulations regarding blood-borne pathogens. The regulations place a new mandate on all employers who have employees at risk for transmission of blood-borne pathogens including many county and city employees. This regulation is specifically directed toward hepatitis B and HIV. There are three mandates which must be satisfied by employers by providing, at no cost to the employee: • yearly education on transmission and prevention of transmission of blood- borne pathogens • immunization for hepatitis B of any employee who is in an "at risk" category and consents to an immunization • a written post exposure policy for the employee which is to include HIV testing and counseling, hepatitis B testing and prophylaxis. The Communicable Disease Program has been working with the Office of Risk Management to implement this program as soon as possible because of OSHA's May 1 implementation date. In addition to employees of the county who must be considered in this mandate the Communicable Disease Program has also been working with the City of Richmond to assist in their implementation of this mandate. Along with the City of Richmond we have applied for a grant from California OSHA to allow us to fund our implementation of these newly required trainings. This regulation is extremely important for the protection of those at risk in the work force. The health care worker, emergency responder, police and fire services are at potential risk every day from both hepatitis B and HIV. It is reasonable and of great value to immu- nize these workers where we can. In this country one health care worker a day dies of occupationally acquired hepatitis B. This is 100% preventable. IMMUNIZATIONS The Federal Centers for Disease Control recently issued a recommendation that all infants be immunized against hepatitis B in the same cycle as they are immunized for all childhood illness. This requires a major change in the pattern for children visiting their physician or immunization clinics because of the schedule of hepatitis B immunizations. Hepatitis vaccine is costly, more than $7.00 per immunization, and the CDC recommenda- tion does not include any federal money to assist with the implementation. Until federal money is available, it will be a cost to the county if we intend to maintain the community standard of care in our Child Health Screening Clinics and Immunization Clinics. QaI�.Fd Tr.bt, ,, -3 It (92- • 141N ,ES5 ,Vll�0;W t �A E 11� DIC "iIC3N A� = Y t ON ' THE PROWLT i .. . . ......... ► ' gCrack houses, shelters b a T. 1 Ij are where he finds bug Newbe h d Th%.�rw.w.r In Contra Costa County it goes this way: If you get tuberculosis.you'd better take your med- 9 Icine.If you don't,you could go to jail. But It's more likely the county will send Chuck Primous after you.Ile will be relentless. He'll track you down anyplace—at your hoose. on a seedy street corner,at a crack house, in a $� i shelter—to hand you your medicines and watch to be sure you swallow them. `z Some people don't like it at first.But no one a wPrimous hunts down in his twice-a-week rounds is complaining. aRi`h.� M 'NIM : Take the North Richmond man found sitting _z: x on a concrete slab at a street corner. Primous hands isoda and he downs dl NadmI he's ladPImousfinshim. v ► +'+ *9 "No;'he said."If Chuck didn't come here. I e probably wouldn't take my pills.Too much trou- It Is because of people like this and the dis- °�'� # turbing resurgence of a contagious disease long ago thought to be under control that Contra Costa Hyl n R$" County has decided to play hardball. The Incidence of TB has doubled in Contra ` i { 1 � 5 E •^ " Leroy Crenshaw takes this much medication twice a week. sy Costa from the norm of 60 cases in 1987 to 117 in same 1991. It's increasing at about the sace in p Alameda County, up from 149 cases In.1985 to 296 in 1990 and 267 last year. The disease, which can end In death if un- t treated,has been burgeoning nationwide because of poverty and drugs,homelessness and the AIDS S- z, virus,which weakens the Immunes stem. 5. Even years before the epidemic,Contra Costa would send a letter to people with TB who were known to have stopped going to the doctor and taking their antibiotics for the six to 12 months necessary.It ordered them to see the doctor or else. Under the California Health and Safety Code. y it is a misdemeanor for a person with TB,who is a threat to public health and safety,not to get treated.The punishment is jail or a fine. The county still sends out that letter and It has jailed five people,who take their pills behind photo,by htkiral libmlOokked Tribune,} TB technician Chuck Primous.right,talks to a patient on i North Richmond:street corner. see TB,Page A-5 0,,1KLAND TRIBUNE, r: ontinued from Page A-3subject but a disease that can be F cured if drugs are taken consis- bar or. up to six months at a I sit and.ta& 6VIth them , tently over months. time Leroy Crenshaw,43,might not �r uta:for the last.four:Years - O11 the St1�'t.COTD�'l: � have taken the full regimen,of Centra Costa:has also.been send- I�, pills without Primous. Now he's.IAWg out Primous to-,reach people;_ 122"1nOt tQ the , glad to be on the road.to recov- �d"have a, hard:time getting ery:."I want to be here a while," �gYh ...r..... «medical carebecause the . are "b"' S�2Qt fT01I1 the Y b he said. . rom. Ct?!1?It I ?I12 XIOtI@Te rimous drives the patients-toopboor alienated fPand back or gets:.themI s en Y the doctor . to , indi we could ` tdq �, �� ,bus tickets. He tells.them what threaten people !with-jail? but to do if they.get side.effects from eRoo'uldn't"help. them;" Said the.medicine..He,helps them get: ooie Wtse.,county�directorof Chuck 2'cimoas ;, food.stamps and disability pay. . mnnicable,:disease:co'nirol. And he's.always:being hit up for t}'Ptimes'people can'tcomply ._111 ;: a buck and-handing-,one over.• t.;because of their situations,They ,s--now-4.drug resistant disease to He also makes important con- Ejust can't do it,.'I: _ others nections, Man urban communities "Tle mortality.rate-is:high if', ,Primous discovered clusters y :aro'i�nd tale nation !lave.level l �yn't take the drugs," Wise ` .af people getting.TB from.each' a operd programs vatto.:suirular as * said :•* r ` f-- other at.three.•crack houses: He. e;pects to Contra Costa's , The 5Q year old Primous, a . talked to-them. told:them how " -they're passing the disease;.what. ., T-acking;down•`people*-;i�ntli 'i public health worker who is part'.: y' P g STB is:a very.direct,'very effec private eye,;pariv social worker :the signs are;what it takes to get „�ive.wag of controlling this,'• and sheet psychologist, has no better. +raid George., Rutherford::,who ;` easY',task "Sometimes they'll snitch on ds .the'state_health depart die+has had to gain tite confi each other and say,`He's not tak- infectious disease -de of garanoidrpeople:ltvtng ing his pilts.',Theydon't.want to anch outside thelaw,'.whb at first re get sick again,,, Primous said.. ! But`it's expensive to:send gard hum as:dust another police- By making the links-and:tell- 4 like *son:.Sometimes atients . workers out to find'.patients and Pe P. ing"people-how, to take caret.of, x: .'them. Contra..,Costa :;'.he visits are outright hostile. ;..,themselves,"Chuck is busting up pends about $4a;OQ0 a year, Once some people left illegal the cluster, Wise said: Wise said drugs.out:far him-to see,jus to Some patients are tough cas- "I would love to be able to say: test whether;he .turned theme in es. that. we dd,Ahis;',', said.Robert' to police. Re didn't. Amy, a, crack addict who 1$'enjamin, Alameda,-County's. asked that her real name not be "I'm:.honest with them,"'said commun'i able disease- chief: used,came out of the hospital in Primous,. as he cruised around `It's_a`funding:uuestion" another county arld disappeared Public health officials are also• Richmond'in his red Fier"o.."I'm someplace in Richmond. balking about whether to reesta-: not a social service or probation Primous looked for her for knish sanitariums;as was done in, officer.- know I'm a,public eight weeks, following.her trail "the past to isolate TB patients so. health worker and*I'm not here : all over town.She had flopped in ,y would not spread the,dis- to take anything: away..from : doorways an d-empty garages. ease; while.they were getting. • therrl. Finally he found her.and'got her i'r'trell "I sit.and.,talk with, them'on on regular medication. . TB; spread*, airborne theatreet corner.-I'm not trying "She's doing.OK"' he said. '"droplets when people;cough- is, to be the big,shot:fmm.th4i coun- Primous greets former pa- itsilx•_passed around in°-close ty:I:am,nat thereto judge them.. tients and their relatives:on the uarters.'-The homeless;who street as they bicycle by:.After "or, These are people 'who have " .-Moodyncough, weight loow yet*that their s and been harassed"so,.long,"'he con- ber, yowardsu,u cahe n always to *find emenii 'night sweats are signs of TB;-can tinned. "They sthll_get'.1ooked.at ive it to other shelter residents. as `You people' and-`those pea You need to, Just get out there le.'I don't.go out there with m and cough and I'll find you." :- In.a crack house,':windows are. P g Y Although the tone of Primous nose turned-up because they live anent: 'creating.a conducive, in-a.place that may be Less than know that if they don't meet wit) 'fi'ent for the disease's spread mine." him, they can be sent to jail. when people cough: The patients,. most of whom "They hear that I want to hell Patients who stop taking their live in Richmond,open up to Pri- them but that- I can, also pu >lls pose•.another serious dan- _ mous, alarge man with a warm them in jail," he said. "The I<+ ._ger. The tuberculosis bacteria smile who is easy to talk to. He have learned just how serious w ;can:become resistant to the drug learns.who their friends and rel are about tuberculosis.in thi than was taken; the person can atives are so they,can.be told.to county. They know this. guy i ,get•sick again, not respond to get tested.. He tells them, all here to help them but he is tat `medicine and spread what is about TB, that it's not a taboo ing no crap." ATO San Arancisco gronide * NATION FRIDAY,MAY 1,•1992 U .S. Annou'nces' Plan to Fig Drugmitesistant Tuberculosis . . By Lawrence K.Altman way through their therapy. New York Times TUBERCULOSIS PLAN Direct observation to ensure Atlanta that patients complete the pre- Federal health officials an- Key recommendations in a new scribed course of therapy is now b drug-Resistant Tuber nounced a plan yesterday to plan from the National al Multi- considered an essential step to pre- " - combat the spread of a deadly Task force of the federal Cen- vent the development and further form of tuberculosis, including ters for Disease Control: spread of the deadly form of tuber- stepping up programs to make culosis. sure that patients take their ■Nationwide surveillance of The report was issued by a task medication. drug resistance among TB pa- force appointed by Dr. James 0. The plan, by the U.S. Public tients. Mason, assistant secretary for Health Service, also calls for ■Pilot programs with"direct- ` health, to identify the steps that strengthening anti-tuberculosis ly observed therapy"— could be taken quickly to counter programs in countries from which where medical workers ensure the spread of drug-resistant tuber- people frequently emigrate to the complete compliance with culosis. United States and for tightening treatment—in countries with notification of state and local high TB rates and high emigra- It said failure to follow the rec- health departments about newly tion to the United States. ommendations .would probably arrived infected immigrants. ■New guidelines for legal is- lead to further spread of drug-re- The plan calls on federal offi- sues of TB control,including sistant tuberculosis and an escala- cials to develop new recommenda- quarantining of uncooperative tion of the costs to contain what tions to advise states about possi- contagious patients. has been described as a growing public health threat. ble laws and regulations to detain, ■Housing for homeless or quarantine and care for people transient TB patients for the du- Out of Control who refuse to comply with stan ration of treatment. Officials of the federal Centers dard measures of treatment. E New drugs and voccines.to , for Disease Control have said that The Public Health Service said combat drug-resistant TB tuberculosis is out of control in the it was seeking to develop ways for strains. United States. private and government organiza- tions to pay for the hospital and - Although the overwhelming out-patient care of people infected majority of new cases of tubercu with tuberculosis, including mea- In the United States, the problem losis are caused by strains of the sures to ensure that they take all is a particular concern because bacterium susceptible to drug their medicine. many people whose immune sys- treatment, health officials fear tems are weakened by infection that without aggressive immediate Goal in Jeopardy with HIV, the virus that causes gg In reporting the plan, federal AIDS,also have tuberculosis. action the drug-resistant strains could.gain a major foothold. officials said they still believed The incidence of drug-resistant Federal health officials are they could meet the goal of elimi- tuberculosis is much higher in -now reviewingfederal and state nating tuberculosis from the Unit- many other countries, and some laws and regulations on ed States by the year 2010.But that g quaran- goal has been jeopardized by the cases in the United States have tine; detention, reporting and di. goal of strains of the tuber- been diagnosed among immi- rectly observed therapy of tuber- cle bacterium that have become grants. culosis patients with the aim of resistant to standard anti-tubercu- drafting new guidelines. losis drugs. Drug Resistance But Dr.Dixie Snider and other Drug-resistant strains have Tuberculosis experts say that officials at the Centers for Disease caused at least 17 outbreaks in thedrug-resistant tuberculosis strains ' Control denied that the aim is to United States since 1976; of these, have often developed when pa- develop .new federal or model 13 were reported in 1990 and 1991. tients stop taking.medication mid- state laws.